Terms in this set (121)
opening in what makes up the following?
1. deep inguinal ring
2. superficial inguinal ring
1. opening in
(superior to the mid-inguinal point)
2. opening in
external oblique aponeurosis
(medial to mid-inguinal point)
mid-inguinal point = half b/w ASIS & pubic tubercle. midway of inguinal canal
1. Vit A
= Vit A precursor
= Niacin (Vit B3) precursor (deficiency = pellagra)
Aldose B Deficiency
Hereditary Fructose Intolerance
= results in buildup of fructose-1-phosphate. F1P inhibits gluconeogenesis. Tx =
removal of fructose or sucrose from diet
(hypoglycemia & vomiting with consumption)
review acid base
psoas muscle insertion?
T12-L5 of spinal cord (Fat arrow)
overexpression of what enzyme linked to recurrent colonic adenoma development? protective factor?
= decreases adenomatous polyp formation
diabetic with granulation tissue in ear, severe ear pain. TM intact
Malignant otitis externa
name the bug:
1. gram-neg rod, oxidase+, motile
2. gram-neg, comma shaped, grows in alkaline media
3. gram-neg rod, fast lactose fermenter
4. gram-neg rod, nonmotile, lactose nonfermenter
2. Vibrio cholerae
3. E coli & Klebsiella
acute GI hemorrhage
- effect on ICF & ECF volume
isosmotic volume contraction
isotonic loss of ECF volume, no effect on ICF volume or osmolarity
- effect on ICF & ECF volume
hyposmotic volume contraction
- hypertonic loss of NaCl w/ some ECF loss. Low ECF osmolarity = free water shift into ICF = ICF expansion
hypertonic saline infusion
- effect on ICF & ECF
hypertonic volume expansion
- increase in ECF volume & high ECF osmolarity = shift water from ICF to ECF = ECF expansion
primary polydipsia & SIADH
= effect on ICF & ECF
hyposmotic volume expansion
- expansion of ECF & ICF volume & decrease in osmolarity of both ECF & ICF
- effect on ICF & ECF
hyperosmotic volume contraction
- loss of free water exceeds loss of electrolytes = increased osmolarity & contracted volumes in ICF & ECF
penicillin - preventive effect on PSGN vs ARF?
penicillin preventive a/t acute rheumatic fever
, but do not reduce risk of PSGN
mst common benign lung tumors. asymptomatic
round, "coin" lesion
incidentally found in pts
. Biopsy shows
cartilage, fibrous, & adipose tissue
unfractionated heparin vs LMWH
bind to antithrombin III
= inhibits Factor Xa & neutralizes thrombin
= inhibits Factor Xa only
patients with chronic hemolytic anemia (ex sick cell) susceptible to what deficiency?
folic acid deficiency & macrocytic changes d/t increased RBC turnover
proto-oncogene encodes protein w/ TK activity related to EGF. overexpression =
breast & ovarian cancers
name derivative germ layer:
1. anterior pituitary/ Rathke's pouch (adenohypophysis)
2. posterior pituitary (neurohypophysis)
4. adrenal medulla
5. adrenal cortex
7. retina & optic nerve
8. anterior eye chamber (iris, sclera, ciliary muscle,etc)
1. surface ectoderm
3. neural crest
4. neural crest
6. surface ectoderm
8. neural crest
blot for what
1. Northern blot
2. Southern blot
3. Western blot
4. Southwestern blot
= DNA probe, mRNA sample (gene expression)
= DNA probe, DNA sample
= ab probe, protein sample
= oligonucleotide probe, DNA-bound protein (eg transcription factors)
mixture of deoxygenated blood
pO2 in LA & LV is lower than that in pulm capillaries d/t mixing of oxygenated blood from pulm veins with deoxygenated blood from
(drain into pulm veins) &
(small cardiac veins that drain into LA & LV).
elderly patient with fever, rash, encephalitis, meningitis, flaccid paralysis, CSF shows viral RNA
West Nile Virus
- RNA flavivirus. Arbovirus. transmission via mosquitos
anemia d/t isoniazid
isoniazid = pyridoxine (vit B6) deficiency.
B6 = cofactor for ALA synthase
inhibition of ALA synthase =
with "ringed sideroblasts" accumulation of iron around nucleus in RBC's that cannot form heme
defect in ornithine transport into mitochondria
urea cycle defects
to reduce ammonia accumulation.
acute hemolytic transfusion reaction - type of rxn?
Type 2 HSR
complement-mediated cell lysis
key features CML
- elevated WBC count (> 50,000) - and...
- increased myeloid precursors (bands, metamyelocytes, myelocytes)
- "myelocytic bulge"
- decreased leukocyte alkaline phosphatase
1. Mutation in P vera
2. Reason for peptic ulceration & pruritis in P vera?
JAK2 V617F mutation
= makes hematopoietic stem cells more sensitive to gf's
2. Histamine release from basophils
asthma - diffusing capacity (DLCO)?
asthma associated w/
increased diffusing capacity
d/t increased pulmonary blood volumes
(DLCO = depends on thickness & total SA of alveolar cap membrane, Hct, & total volume of pulm cap blood)
most common metastatic tumors to brain
avoidant/restrictive food intake disorder
avoidance of food intake d/t dislike of sensory experience of tasting or eating food &/or consequence of eating. (not assoc w/ distortion of body image)
CMV pneumonitis - increased risk especially what patients?
transplant patients = increased risk CMV pneumonitis.
CMV = enveloped, dsDNA.
pic = intranuclear & intracytoplasmic inclusions
trophic & cystic fungal forms in lung of HIV pt
- eosinophilic foamy alveolar material (pic) & cystic & trophic forms in "cup in saucer appearance"
valproate - types of seizures
- 1st line
(ethosuximide = 1st line)
HIV - review ARV therapy
Digoxin - MoA of antiarrhythmic effects?
increases vagal output to AV node & conduction system, thus slowing conduction. Does not alter ventricular myocyte AP.
key features of NF-1
single gene AD mutation on Chr 17
cafe au lait spots
- hamartomas of iris
mutation in MTP gene = inherited inability to synthesize apoB, imp part of chylomicrons & VLDL. Lipids abs by small intestine cant be transported into blood = accum in intestine = enterocytes w/ clear or foamy cytoplasm.
COX 2 role in vasculature
COX 2 = inducible enzyme detectable upon activation by inflammatory cell cytokines. expressed on vascular endothelial & smooth muscle cells. plays role in produc of
(anticoagulant + vasodilation)
COX 2 inhib = increased risk CV events
1. optic tract
2. optic radiation
optic tract lesion
= contralateral homonymous hemianopia & contralateral relative afferent pupillary defect (Marcus Gunn pupil)
optic radiation, LGN
- contralateral homonymous hemianopia with nml pup reflexes.
1. 2 factors for osteoclast differentiation
M-CSF & RANK-L
2. decoy RANK-L receptor on osteoclast (reduces osteoclast differentiation & survival)
(estrogen maintains bone mass via inducing OPG production. low estrogen = decrease in OPG to RANKL ratio & increase RANK expression)
- estrogen agonist at bone, antagonist a breast & uterus.
clenched hands with overlapping fingers, small jaws, small eyes, malformed & low-set ears
Edwards (Trisomy 18)
omphalocele, cleft lip & palate, polydactyly
Patau (Trisomy 13)
brain areas most susceptible to ischemic damage
pyramidal cells of hippocampus & neocortex
(layers 3, 5, 6 --> laminar necrosis)
purkinje cells of cerebellum
hippocampus = 1st area damaged w/ global cerebral ischemia
Hairy Cell Leukemia
- middle-aged men
- splenomegaly (hairy cell accumulate in red pulp)
- "dry tap" (unsuccessful BM aspiration)
- no LAD
- Tx = 2-CDA (Cladribine) - adenosine deaminase inhibitor
Vit C deficiency - Sx?
- capillary bleeding, poor wound healing, peridontal disease +/- bony deformities & subperiosteal hemorrhages in kids
review indirect v direct inguinal hernia
atherosclerotic plaques - role of these:
2. vascular smooth muscle cells (VSMCs)
- produce metalloproteinases & tissue factors that degrade ECM, causing formation of large soft lipid-rich core with thinning of fibrous cap
- directly responsible for synthesis of new collagen & ECM (prolonged plaque enlargement --> ECM remodeling & VSMC death --> increased rupture risk)
Dengue fever - natural history
Dengue = ssRNA w/ 4 diff serotypes
= asymptomatic or self-limited dz
= d/t different viral serotype, causes more severe illness, can lead to DHF
basophilic oval inclusions in mature PMNs
- benign leukocytosis (> 50,000) d/t underlying infxn/hemorrhage, malignancy, or acute hemolysis
- nml or increased leukocyte alkaline phosphatase
- increased bands
- increased early mature PMN precursors (myelocytes)
- Dohl bodies (granules) in PMNs
small lymphoid cells with cleaved nuclei & increased N:C ratio
state of chronic myocardial ischemia in which both myocardial metabolism & function are reduced to match a concomitant reduction in coronary BF --> leads to LV systolic dysfunction & decreased CTY but is
(within days) by coronary revascularization.
long term myocardial hibernation can lead to ventricular remodeling (but would take wks to months to recover after reperfusion)
brief, repetitive episodes of myocardial ischemia f/b reperfusion protect myocardium from future prolonged episodes of ischemia. (eg repetitive episodes of angina prior to MI can delay cell death after complete coronary occlusion)
what muscles insert into
- lateral epicondyle
- medial epicondyle
= wrist extensors
= wrist flexors
pt with long standing rheumatoid arthritis undergoes urgent endotracheal intubation for mechanical ventilation. several hours later, developed areflexic paralysis of all extremities
vertebral subluxation (malalignment) of cervical spine
. Atlantoaxial joint prone to subluxation with chronic severe RA. extension of neck during intubation can worsen subluxation & lead to acute compression of spinal cord &/or vertebral arteries.
mechanism of Zenker's diverticulum
cricopharyngeal motor dysfunction
(diminished relaxation of cricopharyngeal muscles during swallowing) --> increased OP intraluminal pressure --> herniation of pharyngeal mucosa thru zone of muscle weakness in posterior hypopharynx --> zenker's (false diverticulum)
drugs assoc w/ osteoporosis
- PPIs (need acidic env to abosorb insoluble Ca)
- Unfractionated heparin
first generation H1-blockers - key effects
- anti-alpha adrenergic
mutations in which genes can lead to HNPCC
mismatch repair genes =
MSH2 & MLH1
, which code for human
MutS & MutL
cricothyrotomy - incision thru which layers?
2. superficial cervical fascia (including subcut fat & platysma muscle)
3. investing & pretracheal layers of cervical fascia
4. cricothyroid membrane
infxns in which space can extend into superior mediastinum & cause acute necrotizing mediastinitis
innervation below dentate line
inferior rectal branch of pudendal nerve
review metabolic alkalosis
effect of statins & bile acid reisns on cholesterol production
stains = decrease hepatic cholesterol production
bile resins = increase hepatic cholesterol & bile acid synthesis
review infective endocarditis- manifestations
hemoptysis, shoulder pain, hand numbness
pancoast tumor located at lung apex (superior sulcus tumor). pain in C8-T2 distribution. atrophy of hand muscles. horner's syndrome.
review male/female genital homologs
type of proteinuria:
1. tubulointerstitial nephritis (damage to PT)
2. multiple myeloma
3. exercise, high fever, emotional stress, cold exposure
4. older, tall, thin adolescent
5. no systemic signs, nml renal function
6. mostly albumin with minimal IgG & a2-macroglobulin
- presence of LMW proteins (b2-microglobulin, Ig light chain, aa's) that're usually reabsorbed in PT
- excess production of LMW proteins
- d/t change in blood flow thru glomerulus. common cause in young adults w/ nml renal function, disappears on repeat testing
- increased protein excretion, nml excretion when supine. renal function nml.
- mostly LMW protein (albumin, transferrin) excreted. minimal loss of bulky proteins
defect causing tetralogy of fallot?
anterior & cephalad deviation of infundibular septum
= malaligned VSD with overriding aorta = RVOT obstruction (systolic murmur) & RVH.
cyanide poisoning - MoA
inhibits oxidative phosphorylation via inhibition of cytochrome c oxidase. Nml PaO2, SaO2, O2 content.
- venous O2 content rises = AV oxygen gradient falls.
nitrites = oxidize Hb to MetHb (Fe3+) = MetHb high affinity for cyanide = cyanohemoglobin
entacapone & tolcapone
= increases quantity of levodopa entering brain (inhibit peripheral COMT)
= also inhibits central DA degradation (inhibit central COMT). hepatotoxic.
CFTR protein = what type of channel?
transmembrane ATP-gated chloride channel
. (CFTR gene = Chr 7)
MoA - penicillins & cephalosporins
bind to PBPs such as transpeptidases
celiac trunk emerges from aorta at what level
identify portal vein on pic
elevated alkaline phosphatase = f/u with what test?
- mostly present in hepatocytes & biliary epithelia. Helps determine whether high AP is of hepatic or bony origin.
3 organisms whose polysaccharide capsule can be conjugated to protein carriers (list 3 protein carriers)
H influenzae Type b
can conjugate to following carrier proteins:
N meningitidis outer membrane protein complex
beriberi vs guillain barre
= segmental demyelination of peripheral nerves + endoneural inflammatory infiltrate
(thiamine def) - demylination of peripheral nerves. no perineural inflammation
1. compensatory hyperinflation of lung
2. obstructive hyperinflation of lung
= occurs in nml lung parenchyma when adjacent lung segments or lobes collapse or are surgically removed
= occurs in nml lung parenchyma when a lung segment or lobe expands d/t obstruction of bronchiole or bronchus supplying it (eg mucus plug or bronchogenic CA)
= heavy chain + beta2-microblobulin
= alpha & beta polypeptide chains
which disease requires restriction of branched chain amino acids in diet?
maple syrup urine disease
= defect in a-KA dehydrogenase = inability to degrade branched chain aa's (isoleucine, leucine, valine) beyond their deaminated a-keto acid state.
- prevents integration of HIV dsDNA into host cell chromosome = prevent HIV mRNA transcription
= fusion inhibitors. bind to gp41& inhibit viral membrane fusion w/ host cell membrane
= CCR5 antagonist = block attachment & entry of CCR5 tropic viruses into CD4+ T cells & macs
symptoms d/t blockage in:
1. brachiocephalic vein
2. superior vena cava
3. subclavian vein
4. axillary vein
= unilateral arm & face swelling
= bilateral arm & face swelling
subclavian & axillary vein
= subclavian is continuation of axillary vein. unilateral arm swelling only.
popliteal cyst (Baker's cyst) = due to inflammation of what
caused by swelling of
gastrocnemius or semimembranosus bursa
on passive extension of arm, there is initial resistance f/b a sudden release of tension as extension is continued
= contralateral spasticity /t UMN lesion & lack of UMN inhibition on spinal stretch reflex arc
UMN lesion = any part of pyramidal system affected:
(internal capsule, medulla, pons, midbrain, corticospinal tracts, precentral gyrus/PMC)
lesion results in what Sx:
globus pallidus externa
globus pallidus interna
- function? (C)
= (extrapyramidal system) contralateral tremor, bradykinesia, rigidity
= decreased motion/movement
= excessive motion/movement
= integrate integrate body states w/ emotions (limbic system), ANS, & conscious experience of visceral sensations
changes in neuronal body after axon is severed
spastic vs flaccid bladder = lesion where?
spastic bladder = UMN lesion
in spinal cord (eg multiple sclerosis). bladder hypertonia (doesn't distend/relax properly). urinary continence throughout day
flaccid bladder = LMN lesion
- large residual volume, trouble emptying bladder. urinary incontinence at end of day d/t pressure from full bladder
microbial DDx for
endothelin receptor antagonists
= decrease pulm vascular resistance & prevent endothelial proliferation. Used to treat PAH &
myxomatous degeneration with pooling of proteoglycans in meda layer of large arteries
cystic medial degeneration
= predisposes to
& aortic dissection. seen in Marfan's.
(myxomatous = pathologic weakening of CT)
order organ susceptibility to infarction:
spleen, brain, kidney, liver, heart
most to least susceptible to infarction:
brain > heart > kidney > spleen > liver
liver = dual blood supply from portal vein & hepatic artery
mitral annular calcification
does not impair valvular function. seen in:
1. women > 60y
2. Hx of MVP
3. chronically elevated LV pressures
microbes that form biofilms
review amino acid derivatives
3 types GABA receptors
GABA-A & GABA-C
= ion channels
benzos, barbiturates, alcohol = bind to GABA-A
path of prostate cancer mets to vertebral column
venous supply from prostate, penis, bladder -->
prostatic venous plexus
--> spreads to lumbosacral spine via
vertebral venous plexus
--> connects to venous supply to brain --> brain mets
TSH, T3, T4 in diagnosis of hypothyroidism
serum TSH = most sensitive for Dx
b/c small changes in thyroid hormone lead to marked changes in TSH.
Hypothyroidism - TSH rises before T4 falls below normal. T3 last to decline in mst pts with hypothyroidism.
treatment for what type of seizures:
1. broad-spectrum anticonvulsants
2. narrow spectrum anticonvulsants
1. focal or generalized seizures at onset
2. focal onset seizures only. avoid in general epilepsy syndromes b/c can aggravate seizure
3. valproate = 1st line for myoclonic seizure
name one analgesic and one antibiotic that can precipitate serotonin syndrome
analgesic - tramadol
antibiotic - linezolid
adding carbidopa to levodopa can worsen what symptoms?
behavioral changes -
anxiety, agitation, insomnia, confusion, delusions, hallucinations
b/c all these are
central effects of dopamine
. Addn of carbidopa = increased DA in brain.
2 mechanisms by which leptin decreases food intake
Leptin acts on
via decreased production of
via stimulating production of POMC =
produced by cleavage of POMC = inhibits food intake
3 drugs that inhibit DHFR
2. pyrimethamine (antimlarial used to treat toxo)
A = descending aorta
B = esophagus
C = trachea
D = arch of azygos vein
E = left pulmonary artery
big circle in middle = ascending aorta
smaller circle adjacent to big one = SVC
Riboflavin = needed for what step?
Vit B2 (Riboflavin
(complex II) TCA cycle to convert succinate --> fumarate
Pure Red Cell Aplasia
rare form of marrow failure with severe hypoplasia of marrow erythroid elements in setting of nml granulopoiesis & thrombopoiesis. (Low RBCs & RBC precursors, but nml WBCs & plts). Associations:
= produces aqueous humor. target of
localized lump rises from surface of skeletal muscle after percussion of muscle with reflex hammer
= sign of myopathy associated w/ hypothyroidism. elevated CK can precede overt hypothyroidism by several years. f/u with TSH level.
mst common cause of death w/ TCA overdose
refractory hypotension & cardiac arrhythmias d/t
inhibition of fast Na channels in cardiac myocytes
newborn with increased tone in all extremities, irritability, feeding intolerance, ANS instability. Mom with poor prenatal care & history of HCV infxn.
Neonatal Abstinence Syndrome
- d/t withdrawal from transplacental opiates d/t maternal drug use.
Tx = methadone or morphine
(note - naloxone/naltrexone is to treat intoxication not withdrawal)
enterococcus - infxn assoc w/ what procedures?
1. GU procedures (eg cystoscopy)
3. OB/GYN procedures
what stimulates hepcidin:
increase hepcidin synthesis
1. high iron levels
2. inflammatory conditions
decrease hepcidin synthesis
2. increased EPO levels
hepcidin = inhibits ferroportin = prevents iron secretion into circulation
- presents in neonates
middle meningeal artery - arises from what?
review - facial artery, ophthalmic artery, occipital artery
HIV & HPV coinfection
HIV = enhances expression of HPV E6 & E7 oncogenes
conditions associated w/ polyhydramnios
- GI obstruction (duodenal/eso/intestinal atresia)
increased fetal urination
- High fetal CO (anemia, parvovirus)
- Multiple gestations
- Maternal diabetes
fever, generalized LAD, facial edema, rash, eosinophilia, internal organ dysfunctionafter started on a drug
- usually 2-8wks s/p drug exposure
- Vancomycin, Minocycline
Pudendal nerve block - landmark and nearby structures?
Pudendal Nerve (S2-S3)
1. ischial spine
2. sacrospinous ligament
Medial to PN: (inadvertent injxn here = hematoma)
1. internal pudendal artery
2. inferior gluteal artery
binding of host cell receptor with following:
3. Parvovirus B19
Erythrocyte P Antigen
= Parvovirus B19
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